September 4 - iFive Alliances2019-09-15T10:21:46Zhttp://ifivealliances.ning.com/forum/topics/september-4?groupUrl=open-minds&xg_source=activity&feed=yes&xn_auth=no2019 Making Managed Care Work…tag:ifivealliances.ning.com,2019-09-05:3234727:Comment:298462019-09-05T18:40:55.358ZPaul Terlemezianhttp://ifivealliances.ning.com/profile/PaulTerlemezian
<p>2019 <a href="https://www.openminds.com/market-intelligence/executive-briefings/making-managed-care-work-for-complex-consumers/" rel="noopener" target="_blank">Making Managed Care Work For Complex Consumers</a></p>
<p>"In the space of a decade, most consumers with complex needs are enrolled in some type of managed care plan. This is 15% of Medicaid consumers with an intellectual and developmental disabilities (see…</p>
<p>2019 <a href="https://www.openminds.com/market-intelligence/executive-briefings/making-managed-care-work-for-complex-consumers/" target="_blank" rel="noopener">Making Managed Care Work For Complex Consumers</a></p>
<p>"In the space of a decade, most consumers with complex needs are enrolled in some type of managed care plan. This is 15% of Medicaid consumers with an intellectual and developmental disabilities (see <a href="https://www.openminds.com/market-intelligence/executive-briefings/i-dd-managed-care-what-are-the-early-lessons-for-providers/">I/DD &amp; Managed Care – What Are The Early Lessons For Providers?</a>), and 40% of consumers who are dually eligible for Medicaid and Medicare are in some type of managed care plan (see <a href="https://www.openminds.com/market-intelligence/executive-briefings/planning-for-the-changing-dual-eligible-market-opportunity/">Planning For The Changing Dual Eligible Market Opportunity</a>). This has been a big shift for executives of health plans and provider organizations."</p>
<p>Will professional development be more or less complex - or about the same in the forseeable future?</p>
<p>In any event - we are likely to continue our efforts to innovate to improve outcomes.</p>
<p>"What are the keys for any provider organization management team looking to position itself to support this strategy? The answer according to Mr. Hammond is</p>
<ul>
<li>consumer engagement,</li>
<li>population management, and</li>
<li>value-based reimbursement (VBR)—</li>
<li>with a heavy dose of strategic alliances and</li>
<li>technology"</li>
</ul>
<p>Which of these are current competencies? Which are opportunities for improvement? What ideas and initiatives do you have for improvement?</p> 2014 How Does Managed Care Af…tag:ifivealliances.ning.com,2019-08-18:3234727:Comment:292582019-08-18T00:50:31.556ZPaul Terlemezianhttp://ifivealliances.ning.com/profile/PaulTerlemezian
<p>2014 <a href="https://www.openminds.com/market-intelligence/executive-briefings/managed-care-affect-delivery-medicaid-rehabilitation-option-services.htm/" rel="noopener" target="_blank">How Does Managed Care Affect Delivery Of Medicaid Rehabilitation Option Services</a></p>
<p>"</p>
<p>Examples of behavioral health services provided under the rehab option include:</p>
<ol>
<li>Individual and group therapy</li>
<li>Crisis intervention</li>
<li>Family psychosocial education</li>
<li>Peer…</li>
</ol>
<p>2014 <a href="https://www.openminds.com/market-intelligence/executive-briefings/managed-care-affect-delivery-medicaid-rehabilitation-option-services.htm/" target="_blank" rel="noopener">How Does Managed Care Affect Delivery Of Medicaid Rehabilitation Option Services</a></p>
<p>"</p>
<p>Examples of behavioral health services provided under the rehab option include:</p>
<ol>
<li>Individual and group therapy</li>
<li>Crisis intervention</li>
<li>Family psychosocial education</li>
<li>Peer support and counseling</li>
<li>Basic life and social skills training</li>
<li>Medication management</li>
<li>Community residential services</li>
<li>Supported employment</li>
<li>Recovery support and relapse prevention training</li>
<li>Partial hospitalization</li>
<li>Assertive community treatment"</li>
</ol>
<p>What services could do we offer that are analogous to these?</p> 2018 Medicare NextGen ACOs Ge…tag:ifivealliances.ning.com,2019-03-03:3234727:Comment:278422019-03-03T01:02:24.608ZPaul Terlemezianhttp://ifivealliances.ning.com/profile/PaulTerlemezian
<p>2018 <a href="https://www.openminds.com/market-intelligence/news/nextgen-acos-generated-62-million-net-savings-to-medicare/" rel="noopener" target="_blank">Medicare NextGen ACOs Generated $62 Million - About 1.1% In Net Savings</a></p>
<p>Saving $ is one thing to measure - and in this case the $ were saved for Medicare. Were the costs shifted to providers - or patients? What about the outcomes?</p>
<p>Ironically - elearning cost more to develop than ILT and likely costs less to deliver. It…</p>
<p>2018 <a href="https://www.openminds.com/market-intelligence/news/nextgen-acos-generated-62-million-net-savings-to-medicare/" target="_blank" rel="noopener">Medicare NextGen ACOs Generated $62 Million - About 1.1% In Net Savings</a></p>
<p>Saving $ is one thing to measure - and in this case the $ were saved for Medicare. Were the costs shifted to providers - or patients? What about the outcomes?</p>
<p>Ironically - elearning cost more to develop than ILT and likely costs less to deliver. It may also cost the learner less to consume. Will emerging technologies and mindsets allow us to measure outcomes?</p>
<p></p>
<p></p>
<p></p>
<p></p> 2015 State Initiatives To Ass…tag:ifivealliances.ning.com,2016-03-28:3234727:Comment:199392016-03-28T22:53:37.542ZPaul Terlemezianhttp://ifivealliances.ning.com/profile/PaulTerlemezian
<p>2015 <a href="https://www.openminds.com/market-intelligence/executive-briefings/state-initiatives-assure-appropriate-prescribing-antipsychotics-children.htm/" target="_blank">State Initiatives To Assure Appopriate Prescribing of Psychotics to...</a></p>
<p>"A recent Office of the Inspector General report on five state’s Medicaid fee-for-service (FFS) claims found that in 2011, 53% of children were poorly monitored for side effects, health problems, and drug effectiveness (see…</p>
<p>2015 <a href="https://www.openminds.com/market-intelligence/executive-briefings/state-initiatives-assure-appropriate-prescribing-antipsychotics-children.htm/" target="_blank">State Initiatives To Assure Appopriate Prescribing of Psychotics to...</a></p>
<p>"A recent Office of the Inspector General report on five state’s Medicaid fee-for-service (FFS) claims found that in 2011, 53% of children were poorly monitored for side effects, health problems, and drug effectiveness (see <a href="https://www.openminds.com/market-intelligence/news/92-second-generation-antipsychotic-drug-use-among-medicaid-enrolled-children-off-label-2011.htm/">92% Of Second-Generation Antipsychotic Drug Prescriptions For Medicaid-Enrolled Children Was Off-Label</a>)."</p>
<p>With all the concern and scrutiny associated with health care - how could this happen? If this happens then how much attention is given to assure that children are monitored to assure effective education&gt;</p>
<p>Within the workplace - do we assume that study and learning habits are fully formed and effective? Does it make sense to simply dispense education and leave assimilation, application, effectiveness and abandonment up to the individual without monitoring?</p> 2014 How Does Managed Care Af…tag:ifivealliances.ning.com,2016-03-28:3234727:Comment:201602016-03-28T22:41:55.143ZPaul Terlemezianhttp://ifivealliances.ning.com/profile/PaulTerlemezian
<p>2014 <a href="https://www.openminds.com/market-intelligence/executive-briefings/managed-care-affect-delivery-medicaid-rehabilitation-option-services.htm/" target="_blank">How Does Managed Care Affect Delivery Of Medicaid Rehabilitation Op...</a></p>
<p>As I think about health care - its costs and the behaviors, the genetics and the environment - I think that:</p>
<p>1. Government needs to oversee the environment to be sure we are not creating unhealthy outcomes</p>
<p>2. There is benefit to…</p>
<p>2014 <a href="https://www.openminds.com/market-intelligence/executive-briefings/managed-care-affect-delivery-medicaid-rehabilitation-option-services.htm/" target="_blank">How Does Managed Care Affect Delivery Of Medicaid Rehabilitation Op...</a></p>
<p>As I think about health care - its costs and the behaviors, the genetics and the environment - I think that:</p>
<p>1. Government needs to oversee the environment to be sure we are not creating unhealthy outcomes</p>
<p>2. There is benefit to unbiased studies of genetic impacts to healthcare so individuals can be educated on lifestyle choices that their genetic makeup might make them more likely to have negative outcomes</p>
<p>3. We all need to be responsible for our behaviors and that includes the impact of our behaviors to our own health and the health of ours (e.g. smoking and second-hand smoke)</p>
<p>4. The costs need to be managed over our lifetime and be shared in a manner that sustains the highest quality of life for everyone and preserves human dignity. This may mean that there is some "work" that can be done or "research" that will benefit others that occurs at a "cost" to those who have an unhealthy experience related to their genetics, their behaviors or the environment. Perhaps the "earnings" from this work could be used to defray the costs of their healthcare.</p>
<p></p>
<p>With education/learning/workplace performance are there also likely correlations to environment, genetics, behavior and costs?</p>
<p></p>
<p>1. While reducing the cost of education may have benefits - what does it do to insure assimilation, application, effectiveness and abandonment?</p>
<p>2, How can we educate parents on healthy life styles that impact the unborn child's ability to learn?</p>
<p>3. How can we expose children to career options so that their choices are not constrained by their immediate environment?</p>
<p>4, How can we improve everyone's awareness of the consequences of choices?</p>
<p>5. How can we encourage open, inquisitive - purpose driven minds - at every age?</p>